In Japan, as in the United States, the change from home to health care institution as the location of birth has been marked by depicting the obstetrician as having authoritative knowledge about birthing. The obstetrician's access to and control over specialized obstetrical technology reflect and legitimate his authoritative status. In Japan a prevailing cultural view of birth as a natural and healthy event places a value on using the least possible amount of obstetrical intervention in the birthing process. This results in the valuation of the potential, rather than the actual, application of obstetrical technology. In contemporary Japan midwives remain integral participants in maternity care and attend normal deliveries in the hospital setting. But because of the culturally depicted potential for pathology at the time of birth, the obstetrician-the birthing specialist who controls the more complex technological tools-is viewed as having greater authoritative knowledge than the midwife and the woman giving birth.